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Contraindication ESWT anticoagulants

Can you please give some clarity regarding which anticoagulants and antiplatelets you would consider as a contraindication to shockwave. E.g Asprin ? Clopidogrel ? Ticagrelor

tanya

3 weeks ago

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Cliff Eaton
Cliff Eaton

Dear Tanya Luis is quite right. High energy ESWT (lithotripsy) is contraindicated by the ISMST and DIGEST. The low/medium energy clinic units are not although caution is advised especially with thin skin or a history of bleeds. Petechiae can be caused by RPW as the high frequency ultrasonic wave in a standard 15mm creates cavitation superficially which can cause bubbles in superficial blood vessels. The risk of this can be lessened by ensuringvthe use if plenty of gel. Shockwaves travel well through water and not through air Cliff

Cliff Eaton
Cliff Eaton

Dear Tanya Luis is quite right. High energy ESWT (lithotripsy) is contraindicated by the ISMST and DIGEST. The low/medium energy clinic units are not although caution is advised especially with thin skin or a history of bleeds. Petechiae can be caused by RPW as the high frequency ultrasonic wave in a standard 15mm creates cavitation superficially which can cause bubbles in superficial blood vessels. The risk of this can be lessened by ensuringvthe use if plenty of gel. Shockwaves travel well through water and not through air Cliff

Cliff Eaton
Cliff Eaton

Dear Tanya Luis is quite right. High energy ESWT (lithotripsy) is contraindicated by the ISMST and DIGEST. The low/medium energy clinic units are not although caution is advised especially with thin skin or a history of bleeds. Petechiae can be caused by RPW as the high frequency ultrasonic wave in a standard 15mm creates cavitation superficially which can cause bubbles in superficial blood vessels. The risk of this can be lessened by ensuringvthe use if plenty of gel. Shockwaves travel well through water and not through air Cliff

luisef258
luisef258

Hello Tanya In fact the literature is neither abundant nor very clear on this subject. In my experience, using RSWT, the appearance of petechiae, which resolve within 48 to 72 hours, can occur in patients without coagulation pathology or medicated with augticants, when treating shoulders or elbows. On the other hand, I have never verified this occurrence, or more extensive hemorrhages, in the treatment of the plantar fascia, even in patients  in treatment with anticuagolantes. It seems to me that there is some direct relationship with the thickness and cutaneous fragility of the area to be treated. So, in my opinion, the use of RSWT in anticoagulated patients seems to me to be a precaution rather than a contraindication, just as patients on antiplatelet and anticoagulant therapy have to take some precautions mesures with the direct impact on the body. Also ISMST (https://www.shockwavetherapy.org/about-eswt/indications/), indicates as contraindicated only high focal shock waves in severe coagulopathies. Hope this helps.

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